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Review Article on Surgery for Urologic Cancers

Transperineal : a review of technique

Alice Thomson1, Mo Li1,2, Jeremy Grummet3,4, Shomik Sengupta1,2,5

1Urology Department, Eastern Health, Box Hill, Victoria, Australia; 2Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; 3Urology Department, Alfred Hospital, Prahran, Victoria, Australia; 4Central Clinical School, Monash University, Prahran, Victoria, Australia; 5Department of Surgery, University of Melbourne, Heidelberg, Victoria, Australia Contributions: (I) Conception and design: S Sengupta; (II) Administrative support: S Sengupta; (III) Provision of study material or patients: None; (IV) Collection and assembly of data: A Thomson, M Li; (V) Data analysis and interpretation: A Thomson, M Li; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Professor Shomik Sengupta. Eastern Health Clinical School, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia. Email: [email protected].

Abstract: As the second most diagnosed cancer worldwide, is confirmed via tissue biopsy. Given the large number of prostate performed each year, the technique should be as accurate and safe as possible for the patient’s well-being. Transrectal ultrasound guided prostate biopsy (TRUS-biopsy) is most offered worldwide. Transperineal biopsy (TPP-biopsy), on the other hand, has been gaining popularity due to its superior sensitivity and lower rate of sepsis. This article offers a review of the grid technique used to perform a TPP-biopsy, as well as a discussion of possible variations in the procedure. TPP- biopsy is typically performed under general anaesthesia with patient in lithotomy. Through the perineum, cores of tissue are taken systematically, with or without targeting, under US guidance. Different fusion techniques (cognition, MRI-US fusion software, MRI in-bore) can be used to target pre-identified lesions on MRI. The sampling can be done either by free hand or using a brachytherapy grid. Robotic assisted prostate biopsy is also available on the market as an alternative. In recent years, there has been accumulating evidence showing that it is safe and feasible to perform TPPB under local anaesthesia. This may improve the uptake of TPPB as the preferred biopsy technique for prostate cancer.

Keywords: Prostate cancer; transperineal prostate biopsy (TPP-biopsy); transrectal prostate biopsy

Submitted Oct 02, 2019. Accepted for publication Dec 24, 2019. doi: 10.21037/tau.2019.12.40 View this article at: http://dx.doi.org/10.21037/tau.2019.12.40

Background as the specificity for significant prostate cancer (3). It is estimated that over two million men undergo prostate Prostate cancer is the second most frequently diagnosed biopsy world-wide each year. As such, it requires that the cancer worldwide, and the fifth leading cause of cancer technique is as accurate and safe as possible for the patient’s death in men (1). Most guidelines recommend screening well-being (4). for PCa for well-informed men with more than seven Tissue biopsy can be obtained using either transrectal to ten years of life expectancy (2). The process involves ultrasound guided biopsy (TRUS-biopsy) or transperineal performing a clinical history, digital prostate biopsy (TPP-biopsy). TRUS-biopsy is the most (DRE) and serum testing of prostate specific antigen (PSA). commonly offered worldwide as it can be performed in a Prostate biopsy is performed on the basis of screening clinic setting with local anaesthesia. TPP-biopsy is typically results, and remains the gold standard for diagnosis. This a day procedure often requiring general anaesthes